The World Health Organization says its response to the H1N1 pandemic could have been better, but was not unduly swayed by drug manufacturers.

The World Health Organization says its response to the H1N1 pandemic could have been better, but was not unduly swayed by drug manufacturers.

"We are under no illusions that this response was the perfect response," Keiji Fukuda, MD, the agency's top flu expert, told a hearing being held by the Council of Europe's health committee.

But he added, "The influenza pandemic policies and responses recommended and taken by WHO were not improperly influenced by the pharmaceutical industry."

The council's hearing is a response to criticism by some European politicians, as well as elements of the media, that the danger of the H1N1 pandemic was exaggerated, perhaps to allow drug companies to score multimillion-dollar contracts for vaccines and antivirals.

In North America, many experts defended the response to the outbreak, which WHO last April declared a phase six pandemic -- the highest level. The phases reflect that an infectious agent is widely spread and causing disease in the community, but they say nothing about the severity of the disease.

"I do not believe that the record supports the claim that health officials in the U.S. or WHO exaggerated the threat," said Andy Pavia, MD, of the University of Utah in Salt Lake City.

Pavia said in an e-mail that health officials had a choice -- to assume the threat was minor or to react strongly.

"The choice is obvious," Pavia said, "and I would not want to be in a position of explaining to the families of victims why we planned for the mildest outcome."

For the most part, illness caused by the disease has been mild, although several thousand people have died around the world and many more were sick enough to require intensive care.

But the relatively low number of deaths has prompted Wolfgang Wodarg, MD, a German member of the council's Parliamentary Assembly, to dub the outbreak a "false pandemic" and call for this week's hearing.

"What we have experienced now is that millions of people have been vaccinated unnecessarily," Wodarg said. "This is damage done to people, in order to earn money."

Fukuda, on the other hand, said today the pandemic "is a scientifically well-documented event."

"The labeling of the pandemic as "fake" is to ignore recent history and science," he said, "and to trivialize the deaths of over 14,000 people and the many additional serious illnesses experienced by others."

Utah's Pavia echoed that sentiment. Ask any front-line doctor if the H1N1 flu was mild, he said, "and prepare to get your head handed to you."

One of them was Daniel Hinthorn, MD, of the University of Kansas Medical Center in Kansas City, Kan. "As a physician who saw many patients with this disease, I believe it was very serious in many people," he wrote in an e-mail. "The threat was not exaggerated, at least to my mind."

Even last month, as flu activity in the U.S. declined, he said his hospital treated 11 inpatients for the flu, including six in intensive care, while "lots of others" were being seen in emergency wards and clinics.

On the other hand, to say the threat was exaggerated "is merely to say the obvious," argued Philip Alcabes, PhD, of City University of New York City. By the time a vaccine was available, "this outbreak was far less serious than feared," he said in an e-mail.

But "reality-based skepticism about swine flu" doesn't mean that people would refuse immunization -- not if an outbreak was a real public danger, caused by a "highly transmissible agent, likely to be virulent, highly preventable with reliably effective vaccine."

He warned that public health professionals must avoid "falling in love with the most dire forecast and then pushing high-tech precautions against the worst-case scenario."

When that happens, "people have to be excused for wondering whether the officials, the media, and the pharmaceutical companies were in cahoots on swine flu," he said.

But several experts argued that preparing for a worst-case scenario was the responsible thing to do.

Sometimes, "mother nature throws us a break," argued Howard Markel, MD, PhD, of the University of Michigan in Ann Arbor.

"We responded to a threat without knowing the future," he said in an e-mail. "A far worse outcome might have occurred if we did not take the threat seriously and H1N1 turned out to be worse than we initially predicted."

The public health response should be compared to the use of seat belts or auto insurance, according to Gregory Poland, MD, of the Mayo Clinic in Rochester, Minn.

Every day, he said in an e-mail, he puts on his seat belt before driving. "I don't finish each day and say 'What a waste, I didn't have an accident,'" he said.

"It is (and remains) unpredictable as to whether this virus could further mutate or change in a manner such that it could literally turn deadly within weeks," he said. "If this pandemic had been deadly (and you don't know until you are into it) and we weren't prepared, the criticism would have been overwhelming." Poland said.

He and others also noted that the flu season isn't over yet.

"This argument should be taking place at the end of the flu season in late March, not now," said Peter Katona, MD, of the University of California Los Angeles. "Flu is unpredictable, and this is the heart of the argument."

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